BONE-PLASTIC ORBITOTOMY BY METHOD OF KRENLANE IN THE SURGICAL TREATMENT OF CAVERNOUS HEMANGIOMAS OF THE ORBIT

The article is devoted to the description of three clinical cases of patients with rare pathology - cavernous hemangioma of the orbit cavity operated in the neurosurgery clinic of Novosibirsk Research Institute of Traumatology and Orthopedics. The aim of the study was to evaluate the results of surgical treatment of orbital masses through the example the Krenlane method of cavernous angioma orbitotomy in the neurosurgical clinic. Material and methods. 20 people with primary and secondary (growing into the orbit cavity) orbit tumors were operated in the neurosurgery clinic from 2007 to 2016. Among these 20 tumor cases (0.65 % of all brain tumors have been removed in the clinic during this period) there were 13 meningiomas (65 %); 4 gliomas of the optic nerve (20 %); 3 cavernous angiomas (15 %). 3 patients had volumetric formations localized directly into the orbital cavity without spreading into the optic nerve canal and intracranial. In all 3 cases, tumors were cavernous hemangiomas confirmed by pathomorphological studies. Results. All operated cavernous hemangiomas were removed totally. The patients’ postoperative course was smooth, wound healing went by primary tension. Visual acuity deterioration was not observed. According to the results of MSCT control, there were no tumor signs in the early postoperative period (the next day after the operation). All patients were dismissed in satisfactory condition on the seventh day. Control tests, including an MRI after 5 years from the time of the operation showed that the operated patients did not complain. Exophthalmos regressed completely. Visual acuity in all patients recovered to 1.0. Cosmetic defect was absent. All patients had a good functional result - a complete restoration of eyeball movement. Conclusions. Patients with primary volume formations of the orbit cavity in the form of cavernous hemangiomas of lateral localization can be successfully operated with the use of minimally invasive access - bone-plastic orbitotomy, by the method of Krenlane with its proper technical execution. The access is of low-traumatic nature, allows for a wide view of the orbit cavity, provides the necessary operational space and visualization of the surgeon’s manipulation zone, which allows to perform radical removal of the tumor as much as possible without damaging healthy tissues, large vessels and the optic nerve, is well tolerated by patients.

orbitotomy, tumors of the orbit, orbital cavernous hemangioma, accesses to the orbit, Krenlane

1. Алтынбаева Л.Р., Сережин И.Н., Акчурина Р.А. Дифференциальная диагностика гемангиом и других объемных образований орбиты // Казан. мед. журн. 2015. 96. (3). 361-364.

2. Бровкина А.Ф. Болезни орбиты: руководство для врачей. 2-е изд. М.: Медицинское информационное агентство, 2008. 256 с.

3. Готко А.В., Kivelev J.V., Сон А.С. Кавернозные мальформации головного и спинного мозга // Укр. нейрохирург. журн. 2013. (3). 10-15.

4. Григорьева Н.Н., Серова Н.К., Черекаев В.А., Белов А.И., Шишкина Л.В., Щурова И.Н. Характеристика глазодвигательных нарушений у больных с кавернозными гемангиомами орбитокраниальной локализации: клиническая картина и результаты хирургического лечения // Актуальные вопросы нейроофтальмологии: мат. ХII науч.-практ. конф., Москва, 28 января 2011 г. М., 2011. 9-11.

5. Линник Л.Ф., Яровой А.А., Булгакова Е.С. Удаление опухолей орбиты методом костно-пластической орбитотомии по методу Кренлейна-Берке // Вестн. ОГУ. 2007. (78). 139-140.

6. Олюшин В.Е., Рябуха Н.П., Закодырин Д.Е. Хирургическое лечение сосудистых новообразований краниоорбитальной области и глазницы // Рос. нейрохирург. журн. 2010. 2. (2). 36-40.

7. Светицкий П.В., Карнаухов Н.С. Киста орбиты // Междунар. журн. прикл. и фундам. исслед. 2017. (4). 522-525.

8. Стешенко О.Н. Осложнения при проведении орбитотомий: обзор литературы // Все новости офтальмологии. 2012. http://www.eyenews.ru/news/item107880.

9. Черекаев В.А., Серова Н.К., Белов А.И., Кудрявцева П.А., Бочаров А.А. Кавернозная гемангиома зрительного канала и верхней глазничной щели // Вопр. нейрохирургии. 2006. (3). 40-42.

10. Ansari S.A., Mafee M.F. Orbital cavernous hemangioma: role of imaging // Neuroimaging Clin. N. Am. 2005. 15. (1). 137-158.

11. Brusati R., Goisis M., Biglioli F., Guareschi M., Nucci P., Gianni A.B. Surgical approaches to cavernous haemangiomas of the orbit // Brit. J. Oral. Maxillofac. Surg. 2007. 45. 457-462.

12. Fay A., Rodgers I.R. Vascular anomalies of the eyelid and orbit // Albert & Jakobiec’s Principles and Practice of Ophthalmology. 3rd ed. Philadelphia, 2008. 3005-3019.

13. Hassler W., Schaller C., Farghaly F., Rohde V. Transconjunctival approach to a large cavernoma of the orbit // Neurosurgery. 1994. 34. 859-861.

14. Kersten R.C., Kulwin D.R. Vertical lid split orbitotomy revisited // Ophthalmic Plast. Reconstr. Surg. 1999. 15. 425-428.

15. Kuratti H., Bulur B., Bilgic S. Transconjunctival approach for retrobulbar intraconal orbital cavernous hemangiomas. Orbital surgeon´s perspective // Surg. Neurol. 2005. 64. (6). 71-74.

16. Muller-Forell W., Pitz S. Orbital pathology // Eur. J. Radiol. 2004. 49. (2). 105-142.

17. Rose G.E. The «Devil’s touch»; visual loss and orbital surgery. A synopsis of the Mustardé Lecture, 2006 // Orbit. 2007. 26. (3). 147-158.

18. Rosca T.I., Pop M.I., Curca M., Vladescu T.G., Tihoan C.S., Serban A.T., Bontas E.A., Gherghescu G. Vascular tumors in the orbit - capillary and cavernous hemangiomas // Ann. Diagn. Pathol. 2006. 10. (1). 13-19.

19. Scheuerle A.F., Steiner H.H., Kolling G., Kunze S., Aschoff A. Treatment and long-term outcome of patients with orbital cavernomas // Am. J. Ophthalmol. 2004. 138 (2). 237-244.